August 23, 2014

Ebola's enduring legacy of trauma

Before he enters the makeshift hospital wards at Sierra Leone's Ebola treatment centre - the largest of its kind in the world - Malcolm Hugo spends several minutes dressing for the job.

The psychologist layers up in a plastic bodysuit, chlorine-rinsed white gumboots, hood, mask, rubber apron, plastic gloves and goggles. As the Australian approaches bedridden patients carrying Ebola, not a millimetre of skin is exposed to the potential harm of the deadly virus.

He says it is too hot to wear the protective outfit for more than half an hour. But it is more impractical in another, more important way: if a patient is too sick to walk, they are normally too sick to talk.

"They come outside the tent and I can sit there and talk to them without protective gear," the Medecins Sans Frontieres volunteer, who has been living in the world's Ebola epicentre since June, told The Sun-Herald.

"The first thing I do (when a new patient is admitted) is get contact numbers of family, so I can ring family to let them know how they're doing. I give them a phone in each tent so they can make calls. I do anything that makes them feel more comfortable."

It is his remit, too, to notify families when patients die.

"The lousy part of the job is telling relatives that their children are dead, telling patients that they they have Ebola - how to deliver that in a sensitive way. The most difficult part is telling people their relatives have died. Particularly children."

The needs of a growing Ebola-affected population have never been greater. Nearly half a million people live in the remote region, their villages spread across an area that is as logistically challenging as it is economically disadvantaged. It is the rainy season, and, as temperatures hover around 30C, downpours hamper movement of both people and supplies on mud roads that are all but impassable.

Hugo, a grandfather and retired clinical psychologist from Adelaide, is the only Australian in a group of around 30 expat medical staff working in the eye of West Africa's Ebola outbreak. An additional 150 to 200 national staff manage nursing, cleaning and burying bodies.

The 80-patient facility has treated approximately 360 suspected cases of Ebola since opening in June. Of the approximately 260 confirmed cases, just 62 have survived. With many deaths beyond the fences of the centre, death figures are much higher.

The disease is passed on by contact with bodily fluids. A single touch of skin against skin is enough to spread the virus. Symptoms can be flu-like and include bleeding and nervous system damage. The latest outbreak has so far killed 1350 people.

In a remote region in a country as poorly resourced as Sierra Leone, Hugo says the virus affects everybody in some way or other.

"A lot of my time is with children, finding places for them to go when their parents die," he says. He has watched as doctors have been forced to remove babies from the breasts of breastfeeding mothers.

With entire families and communities living in fear and grief, the virus brings with it a raft of psychological effects, many of which remain uninvestigated, given the disease's rarity.

"My own observations are that it's extremely traumatic and I don't use that word loosely ... Children are often in a state of shock and not sure what's going on. With adults, some people are a little bit angry, and there's grief.

"I've just come from speaking with a man and woman whose three children have died here in the last three days; it's difficult for them to process that given that they are ill, too." Hugo pauses. "He won't survive, she will."

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Before he enters the makeshift hospital wards at Sierra Leone's Ebola treatment centre - the largest of its kind in the world - Malcolm Hugo spends several minutes dressing for the job.

The psychologist layers up in a plastic bodysuit, chlorine-rinsed white gumboots, hood, mask, rubber apron, plastic gloves and goggles. As the Australian approaches bedridden patients carrying Ebola, not a millimetre of skin is exposed to the potential harm of the deadly virus.

He says it is too hot to wear the protective outfit for more than half an hour. But it is more impractical in another, more important way: if a patient is too sick to walk, they are normally too sick to talk.

"They come outside the tent and I can sit there and talk to them without protective gear," the Medecins Sans Frontieres volunteer, who has been living in the world's Ebola epicentre since June, told The Sun-Herald.

"The first thing I do (when a new patient is admitted) is get contact numbers of family, so I can ring family to let them know how they're doing. I give them a phone in each tent so they can make calls. I do anything that makes them feel more comfortable."

It is his remit, too, to notify families when patients die.

"The lousy part of the job is telling relatives that their children are dead, telling patients that they they have Ebola - how to deliver that in a sensitive way. The most difficult part is telling people their relatives have died. Particularly children."

The needs of a growing Ebola-affected population have never been greater. Nearly half a million people live in the remote region, their villages spread across an area that is as logistically challenging as it is economically disadvantaged. It is the rainy season, and, as temperatures hover around 30C, downpours hamper movement of both people and supplies on mud roads that are all but impassable.

Hugo, a grandfather and retired clinical psychologist from Adelaide, is the only Australian in a group of around 30 expat medical staff working in the eye of West Africa's Ebola outbreak. An additional 150 to 200 national staff manage nursing, cleaning and burying bodies.

The 80-patient facility has treated approximately 360 suspected cases of Ebola since opening in June. Of the approximately 260 confirmed cases, just 62 have survived. With many deaths beyond the fences of the centre, death figures are much higher.

The disease is passed on by contact with bodily fluids. A single touch of skin against skin is enough to spread the virus. Symptoms can be flu-like and include bleeding and nervous system damage. The latest outbreak has so far killed 1350 people.

In a remote region in a country as poorly resourced as Sierra Leone, Hugo says the virus affects everybody in some way or other.

"A lot of my time is with children, finding places for them to go when their parents die," he says. He has watched as doctors have been forced to remove babies from the breasts of breastfeeding mothers.

With entire families and communities living in fear and grief, the virus brings with it a raft of psychological effects, many of which remain uninvestigated, given the disease's rarity.

"My own observations are that it's extremely traumatic and I don't use that word loosely ... Children are often in a state of shock and not sure what's going on. With adults, some people are a little bit angry, and there's grief.

"I've just come from speaking with a man and woman whose three children have died here in the last three days; it's difficult for them to process that given that they are ill, too." Hugo pauses. "He won't survive, she will."